Comparison of closure versus non-closure of the intraoral buccal mucosa graft site in urethroplasties. A systematic review and meta-analysis

To assess postoperative oral morbidity through meta-analysis of comparative studies for closure or non-closure of the buccal mucosa graft harvest area in patients undergoing urethroplasty. A systematic literature review was conducted in January 2022. Randomized controlled studies were assessed according to the Cochrane collaboration guidelines. Postoperative pain, difficult mouth opening, alteration of oral salivation, perioral numbness, and tolerance of solid and liquid intake results were assessed. Standard mean differences and risk ratios with 95% confidence intervals were estimated for relative risk. Assessment was performed with subgroup analyses according to time points. This meta-analysis included 373 patients in 7 randomized studies. The oral pain overall pooled effect estimates were investigated for the time points of day 0–1, day 3–7 and months 1–6. According to corrected effect estimates after sensitivity analysis, at the day 0–1 time point, the non-closure group was significantly superior compared to the closure group. But there was no difference at the other time points and in total. The overall pooled effect estimates for difficult mouth opening were investigated at 4 time points (day 1, days 5–7, months 1–3 and months 6). After sensitivity analysis, the overall pooled effect estimates at 6 months were significantly superior for the non-closure group. There were no significant differences between the non-closed and closed groups based on the overall pooled-effect estimates for oral numbness, salivary secretion alteration, and tolerance of liquid and solid food variants. The non-closure group was more advantageous in terms of oral pain in the early postoperative period. There were no differences between the groups in terms of alteration of salivation, oral numbness and toleration of liquid/solid food. Although the non-closed group seems more advantageous in terms of ease in mouth movements, more studies are needed to prove this.

本研究旨在通过对尿道成形术患者颊黏膜供区缝合与不缝合的对比研究开展Meta分析（meta-analysis），评估术后口腔并发症发生情况。本研究于2022年1月完成系统文献回顾，随机对照试验（randomized controlled trial, RCT）的质量评价依据考克兰协作网（Cochrane Collaboration）指南进行。本研究评估的结局指标包括术后疼痛、张口困难、口腔唾液分泌改变、口周麻木以及固体与液体食物耐受情况。相对风险采用标准化均差（standard mean difference, SMD）与风险比（risk ratio, RR）结合95%置信区间（confidence interval, CI）进行估计，并按时间节点开展亚组分析。本次Meta分析共纳入7项随机对照试验，涉及373例患者。针对口腔疼痛的总体合并效应量，分别在术后0~1天、3~7天及1~6个月三个时间节点进行分析。经敏感性分析校正效应量后，在术后0~1天时间节点，不缝合组的效果显著优于缝合组；而在其余时间节点及总体分析中，两组未显示出显著差异。针对张口困难的总体合并效应量，分析了4个时间节点：术后1天、5~7天、1~3个月及6个月。经敏感性分析后，仅在术后6个月时间节点，不缝合组的效果显著更优。针对口周麻木、唾液分泌改变以及固体/液体食物耐受情况的总体合并效应量分析显示，两组间均无显著差异。术后早期，不缝合组在缓解口腔疼痛方面更具优势；而在唾液分泌改变、口周麻木及食物耐受情况方面，两组无显著差异。尽管不缝合组在口腔活动便利性方面似乎更具优势，但仍需更多研究予以证实。